Terapia visual: ¿En qué consiste y cuándo indicarla? / Vision therapy: what is it and when should it be indicated?

RESUMEN La terapia visual es un programa de ejercicios visuales personalizados, donde se realiza una estimulación neurofisiológica que nos permite desarrollar, mejorar e integrar las capacidades visuales. Esta serie de actividades específicas están pensadas para corregir problemas de visión. La terapia visual tiene como fin obtener una visión simple, nítida, confortable y eficaz. En la sociedad actual de la información y del conocimiento, donde hay un uso excesivo de la visión de cerca que provoca síntomas oculares como consecuencia del estrés visual, esta es una opción terapéutica a tener presente en sus diferentes variantes(AU)

ABSTRACT Vision therapy is a program of personalized visual exercises by which neurophysiological stimulation is provided to develop, improve and integrate visual capacities. It consists of a series of specific activities designed to correct vision problems. The purpose of vision therapy is to obtain single, neat, comfortable and efficient vision. In today's information and knowledge society, characterized by excessive use of near vision, leading to ocular symptoms resulting from visual stress, this is a therapy option to be taken into account in its various forms(AU)

Preferred clinical practice in convergence insufficiency in India: a survey.

PURPOSE: Convergence insufficiency (CI) is a common binocular vision disorder. However, there is a lack of consensus regarding the treatment most appropriate for CI. The aim of the study was to investigate the treatment for CI by surveying the ophthalmologists regarding the most common treatment modalities used in India. MATERIALS AND METHODS: Four hundred questionnaires were distributed amongst ophthalmologists attending different sessions of the Delhi Ophthalmological Society annual conference held in April 2007. Two hundred and three ophthalmologists responded (response rate 50.75%). The responders included 109 private practitioners, 57 consultants attached to teaching institutes and 37 residents. RESULTS: The majority of ophthalmologists (66.7%) claimed encountering > 5% outpatient department patients with CI. Pencil push-ups therapy (PPT) was the most common first line of treatment offered by ophthalmologists (79%) followed by synoptophore exercises (18%). Only 3% referred the patients to optometrists. Thirty per cent ophthalmologists claimed good results with PPT, which was significantly higher in private practitioners (35%). Only 26% ophthalmologists explained physiological diplopia to patients on a regular basis and reported significantly higher percentage of patients (46.3%) with good results. Only 12.3% ophthalmologists needed to refer > 30% patients for synoptophore exercises. For failure of PPT 86.7% considered lack of compliance as the major reason as perceived by ophthalmologists. CONCLUSIONS: This survey suggested that most ophthalmic practitioners prescribed PPT as the initial treatment for CI and had satisfactory results with PPT. The majority of the practitioners did not explain to the patient about physiological diplopia. Explaining physiological diplopia may improve outcome, as perceived from the survey.

The outcomes of horizontal strabismus surgery and influencing factors of the surgical success.

OBJECTIVES: To evaluate the surgical outcomes of horizontal strabismus and identify the influencing factors of the surgical success. MATERIAL AND METHOD: The medical records of 304 patients who underwent their first strabismus surgery for treatment of horizontal deviation at Siriraj Hospital were reviewed retrospectively from January 1998 to December 2003. The main outcome measure for successful surgery was defined as eye deviation 10 prism diopters or less at 6 weeks post-surgery. The outcomes of postoperative binocular function and visual acuity improvement were also evaluated. The pre operative deviation, diagnosis, binocular function, visual acuity and age were analyzed as influencing factors of surgical success. The patients were divided into two groups, the first group was 6 years or less (161 cases) and the second group was older than 6 years (143 cases). The statistical methods for analysis the data were Chi-square test, Mann-Whitney U test and Logistic regression. RESULTS: The follow- up period was from 3 to 12 months. 187 patients (61.5%) for esotropia and 117 patients (38.5%) for exotropia were identified. Mean patient's age was 10.5 +/- 10.2 years (median 6, min 0.5, max 53), mean preoperative deviation was 44.9 +/- 16.6 prism diopters and mean VA was 20/30 (no PL, 20/20). The success rate was 62.0% for esotropia and 57.0% for exotropia. There was no statistical difference between the two groups of diagnosis. The average final deviation postoperative in the success group was 6 +/- 4.9 prism diopters. The comparison of difference visual acuity between pre and post-operation showed no statistical significance but the presence of binocular vision was increased in number of patient by two times. The complication rate was 0.7% (2/304), one case showed conjunctival wound dehiscence and the other had globe perforation. Re-operative rate was 12.9% (39/304) after one year. CONCLUSION: The surgical success rate of horizontal strabismus surgery was 60.2% and revealed no statistically significant improvement of visual acuity after surgery. The successful surgery was related to the age younger than 6 years and preoperative deviation less than 30 degrees.

Genetic aspects of strabismus

Purpose: To evaluate the genetic aspects of strabismus. Methods: Ophthalmic and orthoptic evaluations were performed prospectively on 110 strabismic probands and 478 relatives. We used 3 different criteria in the diagnosis of strabismus: primary diagnósis (dxl) defined as any manifest horizontal or vertical deviation, a secondary diagnosis (dx2) including esophoria (>7 prism diopters) or exophoria (>9 prism diopters), and a tertiary diagnosis (dx3) including abnormal fusional amplitudes, accommodative convergence/accommodation (AC/A) ratio, andor stereopsis; monofixation syndrome; 4 prism diopters base out; and/or abnormal Maddox test responses. Analyses were carried out within mating types. Results: Hypotheses of autosomal dominant or recessive inheritance with no sporadics were rejected. Based on the dx 1, 25 percent of the families had more than one individual affected and there was vertical transmission in 13 percent; adding dx2 there were 36 percent of the families with more than one affected and 21 percent had vertical transmission; and adding dx3, there were 73 percent with more than one affected and 51 percent with vertical transmission. Conclusions: There is evidence for a pattern consistent with an autosomal dominant form of strabismus in most families.

Manejo ortóptico del estrabismo precoz / Orthoptic management of early strabismus

Se hace un resumen del tratamiento ortóptico del estrabismo congénito en niños desde los 6 meses de edad. Se muestra las distintas formas de oclusión. La revisión de historias clínicas demuestra que las cirugías tempranas no garantizan al paciente visión binocular ni estereopsis. El seguimiento ortóptico postquirúrgico es ideal. Con su variedad de formas de tratamiento ayuda a complementar el éxito de la cirugía y mantener en lo posible una buena agudeza visual en ambos ojos

Prism therapy for adult onset strabismus

The Fresnel press-on-prism has dramatically changed the type of patient seen in our Orthoptic Department. More and more orthoptist in the USA are seeing more and more adult patients and are using more and more prisms for the annoying symptoms of diplopia